Skip to main content Accessibility help

Implementing a Multifaceted Intervention to Decrease Central Line–Associated Bloodstream Infections in SEHA (Abu Dhabi Health Services Company) Intensive Care Units: The Abu Dhabi Experience

  • Asad Latif (a1) (a2) (a3), Bernadette Kelly (a4), Hanan Edrees (a1) (a5), Paula S. Kent (a1) (a6), Sallie J. Weaver (a1) (a2), Branislava Jovanovic (a4), Hadeel Attallah (a4), Kristin K. de Grouchy (a7), Ali Al-Obaidli (a4), Christine A. Goeschel (a5) (a8) and Sean M. Berenholtz (a1) (a2) (a9)...



To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line–associated bloodstream infections.


Prospective cohort collaborative.


Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi.


A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line–associated bloodstream infections.


Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line–associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line–associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods.


A significant reduction in the global morbidity and mortality associated with central line–associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.

Infect. Control Hosp. Epidemiol. 2015;36(7):816–822


Corresponding author

Address correspondence to Asad Latif, MD, MPH, 600 N. Wolfe St, Meyer 297-A, Baltimore, MD 21287 (


Hide All
1. Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228241.
2. Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976981.
3. Higuera, F, Rangel-Frausto, MS, Rosenthal, VD, et al. Attributable cost and length of stay for patients with central venous catheter–associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol 2007;28:3135.
4. Rosenthal, VD, Guzman, S, Migone, O, Crnich, CJ. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 2003;31:475480.
5. Rosenthal, VD. Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 2009;49:18991907.
6. Rosenthal, VD, Bijie, H, Maki, DG, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control 2012;40:396407.
7. World Health Organization. Report on the Burden of Endemic Health Care-Associated Infection Worldwide: A Systematic Review of the Literature. Geneva, Switzerland: World Health Organization, 2011. Available at:
8. Rosenthal, VD, Maki, DG, Jamulitrat, S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003–2008, issued June 2009. Am J Infect Control 2010;38:95104.e2.
9. Pronovost, PJ, Berenholtz, SM, Goeschel, C, et al. Improving patient safety in intensive care units in Michigan. J Crit Care 2008;23:207221.
10. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
11. Pronovost, PJ, Goeschel, CA, Colantuoni, E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.
12. Lipitz-Snyderman, A, Steinwachs, D, Needham, DM, Colantuoni, E, Morlock, LL, Pronovost, PJ. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis. BMJ 2011;342:d219.
13. Waters, HR, Korn, R Jr, Colantuoni, E, et al. The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs. Am J Med Qual 2011;26:333339.
14. Sexton, JB, Berenholtz, SM, Goeschel, CA, et al. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med 2011;39:934939.
15. Berenholtz, SM, Lubomski, LH, Weeks, K, et al. Eliminating central line–associated bloodstream infections: a national patient safety imperative. Infect Control Hosp Epidemiol 2014;35:5662.
16. Palomar, M, Alvarez-Lerma, F, Riera, A, et al. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med 2013;41:23642372.
17. Bion, J, Richardson, A, Hibbert, P, et al. “Matching Michigan”: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf 2013;22:110123.
18. Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391402.
19. Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:20142020.
20. Gurses, AP, Murphy, DJ, Martinez, EA, Berenholtz, SM, Pronovost, PJ. A practical tool to identify and eliminate barriers to compliance with evidence-based guidelines. Jt Comm J Qual Patient Saf 2009;35:526532; 485.
21. Agency for Healthcare Research and Quality. Using a comprehensive unit-based safety program to prevent healthcare-associated infections. Published 2012.
22. Barron, WM, Krsek, C, Weber, D, Cerese, J. Critical success factors for performance improvement programs. Jt Comm J Qual Patient Saf 2005;31:220226.
23. Lubomski, LH, Marsteller, JA, Hsu, YJ, Goeschel, CA, Holzmueller, CG, Pronovost, PJ. The team checkup tool: evaluating QI team activities and giving feedback to senior leaders. Jt Comm J Qual Patient Saf 2008;34:619623; 561.
24. WHO Patient Safety. Programme action areas. Updated 2010.
25. Kanj, S, Kanafani, Z, Sidani, N, Alamuddin, L, Zahreddine, N, Rosenthal, V. International Nosocomial Infection Control Consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital. J Glob Infect Dis 2012;4:1521.
26. Jaggi, N, Rodrigues, C, Rosenthal, VD, et al. Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India. Int J Infect Dis 2013;17:e1218e1224.
27. Rasslan, O, Seliem, ZS, Ghazi, IA, et al. Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt: International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 2012;5:394402.
28. Leblebicioglu, H, Ozturk, R, Rosenthal, VD, et al. Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 2013;12:10. doi:10.1186/1476-0711-12-10.
29. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011;39:798816.
30. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
31. Sankaranarayanan, K, Matarelli, S, Parkar, H, Abu Haltem, M. From blame to fair and just culture: a hospital in the Middle East shifts its paradigm. PSQH 2013;July/August:30–35.
32. Sankaranarayanan, K. Getting to zero: correlation between safety culture and infection prevention. AMH 2013.
33. Mauger Rothenberg, B, Marbella, A, Pines, E, Chopra, R, Black, ER, Aronson, N. Closing the Quality Gap: Revisiting the State of the Science (Vol. 6: Prevention of Healthcare-Associated Infections). Rockville, MD: Agency for Healthcare Research and Quality, 2012.
34. Pronovost, PJ, Berenholtz, SM, Needham, DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008;337:a1714.
35. Dixon-Woods, M, Bosk, CL, Aveling, EL, Goeschel, CA, Pronovost, PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Q 2011;89:167205.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed